Oil & Gas Pipeline or Welding Supplemental Questionnaire
800 Gessner, Suite 600 · Houston, Texas 77024
Submissions:
Applicant/Insured Name:PIPELINE INFORMATION:
Type of Pipeline: / Miles / Maximum Diameter / Maximum Operating PSI / Maximum Design PSI
Gathering Lines (runs between well sites)
Transmission Lines (long distance)
Distribution (runs to end users)
What is the annual amount of pipeline constructed that is: / Gross Payroll
Less than 4 inches in diameter?
4-10 inches in diameter?
More than 10 inches in diameter
What percentage of pipeline is:
Above ground: / % / Below ground: / %
Does the pipeline supply any end users? / YES / NO
If yes, does the applicants interest in the pipeline end at the meter? / YES / NO
Does the pipeline transport the applicants own product? / YES / NO
Does the pipeline run through or under any cities, rivers, or any other
bodies of water? / YES / NO
As respects the above Pipeline Construction operations, please complete the below section where applicable;
WELDING/CUTTING: / In Shop / %
In Field / %
What percentages of the applicant's operations involve welding? / %
Number of years experience as a welder?
What welding industry standards does the applicant operate under?
What does the applicant weld?
Does the applicant do any welding on pipelines or containers which have
previously, or still carry any flammable liquids or gases? / YES / NO
Does the applicant do any "hot tap" work? / YES / NO
If yes, who is responsible for closing valves and bleeding pipelines or testing of
containers to make sure they are safe for welding operations?
Percentage of new construction: / %
Percentage of repair and/or maintenance: / %
Any welding over-the-hole? / YES / NO
If yes, what percentage of work is over-the-hole? / %
Does the applicant do any welding in refineries and/or petrochemical plants? / YES / NO
List the companies for which the applicant operates under a contract or agreement to do welding:
Insured Signature /Date
Agent Signature/ Date